Public health and health reform in Australia

The national health reform agenda appears to have omitted public health. In this article, I outline how public health is different from primary care, and why a holistic approach to reform should include public health. The current reform agenda is very much focused on addressing the problems in acute care and the hospital system, with the focus on primary care being a means to this end. Until the health system is addressed as a whole, with all its essential components integrated and interlinked, truly successful reform of the health system, with genuine long-term vision and sustainability, will not be possible.     

卫生技术评估在健康保险和健康管理中的应用

卫生技术评估作为重要的卫生决策工具,能够为决策者的循证决策提供参考依据。梳理了国内外卫生技术评估的程序及内容,回顾了卫生技术评估在国内外健康保险和健康管理领域的应用现状和进展,提出了新时期背景下卫生技术评估应明晰关键角色定位、回归评估目标价值、重视患者参与、保证独立客观、合理使用大数据等发展新要求,同时针对我国卫生技术评估存在的问题,结合国际经验提出了规范设计评估流程、促进决策转化、加强多方交流、提升循证决策意识、保障评估公正透明等相关建议,为促进卫生技术评估在健康保险和健康管理中的应用提供科学依据。     

Challenges in health and health care for Australia

The next Australian Government will confront major challenges in the funding and delivery of health care. These challenges derive from: Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows; Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies; Problems with health workforce supply and distribution; Persistent concerns about the quality and safety of health services; Uncertainty about how best to balance public and private sectors in the provision and funding of health services; Recognition that we must invest more in the health of our children; The role of urban planning in creating healthy and sustainable communities; and Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services. The search for effective and lasting solutions will require a consultative approach to deciding the nation's priority health problems and to designing the health system that will best address them; issues of bureaucratic and fiscal responsibility can then follow.     

加强健康教育与健康促进课程建设的必要性

健康促进,包涵了个人行为改变和政府行为改变两个方面.各国已将健康教育、健康促进作为卫生保健事业发展的重要任务.在我国拟从改变领导阶层健康观入手,制定相关政策,改变医疗卫生部门的职能,形成全社会参与、各部门合作的外部环境,以确保健康促进的实践,医学院校培养的学生应具有健康促进知识和实践健康促进的能力,推动健康促进事业的发展.     

Mental health, pregnancy and self-rated health in antenatal women attending primary health clinics

The purpose of this study was to study the determinants of self rated health in the low-risk pregnant women of Melaka Tengah in Malaysia. A total of 387 subjects were analysed. The role of mental health, psychosocial stressors, support from husband, coping skills, socio-economic status and pregnancy characteristics in determining self- rated health were studied. Health items were taken from the Duke Health Profile. Bad obstetric history, poor mental health, stress from the family were found to be significantly associated with poor self - rated health whereas good support from the husband was related to good self - rated health.     

健康教育和健康促进在社区全科医疗服务中的作用

第 13届世界健康教育大会提出 :健康教育是一门研究传播健康知识和技术、影响个体和群体行为、消除危险因素、预防疾病 ,促进健康的科学”。第 14届世界健康教育大会上又提出 :“健康教育及其相关的理论是一种崭新的科学文化 ,它的着眼点应是如何促使人们建立和形成有益于健康的行为和生活方式 ,以消除危险因素 ,更好地促进和保护人民群众的健康。”我国制定《关于卫生改革与发展的决定》也提出 :“健康教育是公民素质教育的重要内容”。以上所述都表明了健康教育既是整个卫生事业的组成部分 ,又是公民素质教育的重要内容 ,其根本着眼点是 ,…     

徐州市社区居民健康状况和卫生服务需求分析以及对策研究

目的 了解和分析徐州市卫生状况和社区居民卫生服务需求情况,为开展和发展社区卫生服务提供理论基础。方法 利用分层整群抽样和系统分析的方法。结果 在被调查的８２１２人中,统计的３１种慢性病患病人数是２９１６人（３５．５％）,排在首位的是高血压病患者;目前,徐州市社区居民就医主要还是自我医疗（６１．９％）,希望提供的服务是预防和保健服务,对卫生部门意见主要是药费太贵（６３．７％）和诊疗费太贵（４６．２％）;社区居民对卫生知识和晓情况较好,得到卫生知识的渠道主要是通过书报杂志和广播电视。结论 徐州市的社区卫生服务工作亟待开展和发展,同时提出了社区卫生服务工作的政策性建议和具体工作建议。     

Micronutrients in health and disease

Micronutrients play a central part in metabolism and in the maintenance of tissue function. An adequate intake therefore is necessary, but provision of excess supplements to people who do not need them may be harmful. Single micronutrient deficiency states are comparatively easily recognised and treated. Subclinical deficiency, often of multiple micronutrients, is more difficult to recognise, and laboratory assessment is often complicated by the acute phase response. Clinical benefit is most likely in those people who are severely depleted and at risk of complications, and is unlikely if this is not the case. There is little evidence for supplements leading to a reduction in the incidence of infections in the elderly population, in coronary artery disease, or in malignant disease. The best evidence for benefit is in critical illness, and in children in developing countries consuming a deficient diet. More clinical trials are required with good clinical outcomes to optimise intake in prevention and treatment of disease.     

新医改与我国医疗卫生体制的公平性

医疗体制的公平是每个人基本权利的保证条件之一,我国经济快速平稳增长,医疗体制的公平性却不断受到质疑。在宏观形势与医疗体制自身需要的契机下,2009年中国开始了被称为"新医改"的医疗卫生体制改革。从医疗体制公平性角度,分析了改革方案中对医疗筹资、医疗支付和医疗服务机构3个方面的公平性考虑,提出加强累进性最强的税收筹资的力度,以及将财政资金更多地用于医疗需求方,即社会医疗保险的支持,以提高医疗筹资和支付的公平程度。坚持公立医院为主导,充分体现医院服务机构的公益性,也是改革方案中对公平性地体现,反映了新医改对公平性问题的高度关注。最后提出有待进一步明确的关于政府主导与市场调节的兼顾问题,农村医疗保障的完善、医疗筹资中公共资金的适度比例以及中医药的重新定位和重点发展。     

上海市社区卫生服务中健康素养量表的开发和评价

 目的 开发适用于上海市社区卫生服务情景的具有较高信效度的健康素养量表。方法 通过文献评价、深度访谈发展题库及德尔菲法审定条目,结合上海市社区卫生服务环境的实际情况开发量表。采用方便抽样的方法,在上海市某区3家社区卫生服务中心抽取300名候诊者进行问卷调查。采用同质性信度、重测信度和分半信度、内容效度、区分效度等方法进行信效度评价,采用验证性因子分析进行模型验证。结果  获得有效问卷297份(99%)。量表的Cronbach’s α为0.901,各维度的Cronbach’s α分别为0.911、0.861、0.855和0.753;重测信度和分半信度分别为0.637和0.756。因子分析的KMO值为0.891,生成4个公因子可解释65.96%的方差变异。高分组和低分组、不同文化水平、是否从事过医疗行业的人群的得分差异均有统计学意义(P<0.05),说明量表具有区分效度。验证性因子分析得到χ2/df =3.067,近似误差均方根(root mean square error of approximation,RMSEA)为0.054,残差均方根(root of the mean square residual,RMR)为0.082,拟合优度指数(goodness-of-fit index,GFI)、校正拟合优度指数(adjusted goodness-of-fit index,AGFI)、比较拟合指数(comparative fit index,CFI)、规范拟合指数( normed fit index,NFI )、增量拟合指数(incremental fit index,IFI)均接近1,显示模型拟合较好。结论 该健康素养量表在此次调查中显示具有较好的信效度,可应用于上海市社区卫生服务工作。     

主动参与型教学在健康教育与健康促进中的探索?

为了探讨主动参与型教学在健康教育与健康促进实验教学中的效果,在中山大学公共卫生学院2009级、2010级和2011级卫生事业管理专业的本科班学生中,以主动参与型教学方式开展健康教育与健康促进教学,课后进行访谈和问卷调查。结果发现,主动参与型教学模式调动了学生的学习热情,激发了学生的积极性,增加了对该课程具体理论与应用意义的深刻理解,培养了学生创新能力和主动学习的能力,并且合作、交流、自学、分析和解决问题的能力均有所提高,同时也促进了师生之间对知识的交流。因此主动参与型教学模式是提升和促进高等医学院校健康教育与健康促进课程教学质量的有效方法之一。